Reference : Pain perception in disorders of consciousness: Neuroscience, clinical care, and ethic...
Scientific journals : Article
Human health sciences : Neurology
http://hdl.handle.net/2268/111561
Pain perception in disorders of consciousness: Neuroscience, clinical care, and ethics in dialogue
English
Demertzi, Athina mailto [Université de Liège - ULg > > Centre de recherches du cyclotron >]
Racine, Eric [> >]
Bruno, Marie-Aurélie mailto [Université de Liège - ULg > > Centre de recherches du cyclotron >]
Ledoux, Didier [> >]
Gosseries, Olivia mailto [Université de Liège - ULg > > Centre de recherches du cyclotron >]
Vanhaudenhuyse, Audrey mailto [Université de Liège - ULg > > Centre de recherches du cyclotron >]
Thonnard, Marie mailto [Université de Liège - ULg > > Centre de recherches du cyclotron >]
Soddu, Andrea mailto [Université de Liège - ULg > > Centre de recherches du cyclotron >]
MOONEN, Gustave mailto [Centre Hospitalier Universitaire de Liège - CHU > > Neurologie Sart Tilman >]
Laureys, Steven mailto [Université de Liège - ULg > > Centre de recherches du cyclotron >]
4-Jan-2012
Neuroethics
Springer Netherlands
1-14
Yes
1874-5490
[en] Pain ; End-of-life ; Vegetative state ; Minimally conscious state ; Ethics ; Attitudes ; Survey
[en] Pain, suffering and positive emotions in patients in vegetative state/unresponsive wakefulness syndrome (VS/UWS) and minimally conscious states (MCS) pose clinical and ethical challenges. Clinically, we evaluate behavioural responses after painful stimulation and also emotionally-contingent behaviours (e.g., smiling). Using stimuli with emotional valence, neuroimaging and electrophysiology technologies can detect subclinical remnants of preserved capacities for pain
which might influence decisions about treatment limitation. To date, no data exist as to how healthcare providers think about end-of-life options (e.g., withdrawal of artificial nutrition and hydration) in the presence or absence of pain in non-communicative patients. Here, we aimed to better clarify this issue by re-analyzing previously published data on pain
perception (Prog Brain Res 2009 177, 329–38) and end-of-life decisions (J Neurol 2010 258, 1058–65) in patients with disorders of consciousness. In a sample of 2259 European healthcare professionals we found that, for VS/UWS more respondents agreed with treatment withdrawal when they considered that VS/UWS patients did not feel pain (77%) as compared to those who thought VS/UWS did feel pain (59%). This interaction was influenced by religiosity and professional
background. For MCS, end-of-life attitudes were not influenced by opinions on pain perception. Within a contemporary ethical context we discuss (1) the evolving scientific understandings of pain perception and their relationship to existing clinical and ethical guidelines; (2) the discrepancies of attitudes within (and between) healthcare providers and their consequences for
treatment approaches, and (3) the implicit but complex relationship between pain perception and attitudes toward life-sustaining treatments.
http://hdl.handle.net/2268/111561
10.1007/s12152-011-9149-x
http://reflexions.ulg.ac.be/ethiquevieetmort

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